Öz
Amaç: Uzamış turnike zamanı ile eşzamanlı bilateral total diz artroplastisi(TDP) diz fonksiyonlarını olumsuz etkileyebilecek iskemik-perfüzyon yaralanmasını tetikleme potansiyeline sahiptir. Çalışmalar bu yaralanmanın büyüklüğünün vücudun herhangibir yerinde olan iskemik bir hadiseden sonra daha az olduğunu ortaya koymuş ve bu etkiye iskemikönkoşullama (İÖ) adı verilmiştir. Bu çalışmanın amacı oksidatif streslerin kas yaralanması, diz fonksiyonları üzerine etkilerini ve İÖE’nin tek aşamalı bilateral TDP olgularında yaralanma metabolitlerini etkileme ve kötü fonksiyonel sonuçları engelleme potansiyelini araştırmaktır.Çalışma planı: Turnike eşliğinde eş zamanlı bilateral TDP uygulanan 30 hasta bu çalışmaya dahil edildi. Tüm işlemler sağ ekstremiteden başlatıldı. İşlemin bitimini takiben, sol turnike işlem sonunda ilk turnike indirildikten 20 dakika sonra şişirildi. Turnike zamanı kaydedildi. Pre ve postoperatifmalondialdehid (MDH), kreatinkinaz (KK) ve laktatdehidrogenez (LDH) seviyeleri ölçüldü. Diz fonksiyonları postoperatif 1. ayda WOMAC skoru ile değerlendirildi.Bulgular: Her iki ekstremitede MDH, KK ve LDH seviyeleri postoperatif dönemde preopratif döneme göre artmış bulundu. Her iki ekstremitede de serum MDH, CK ve LDH seviyeleri ile turnike süresi arasında ilişki saptanmadı. Solekstremite ile karşılaştırıldığında sağ ekstremitede artmış serum MDH, CK ve LDH düzeyleri ile görülen daha yüksek postoperatifoksidatifstress saptandı. Turnike zamanı ve postoperatif serum MDH, KK ve LDH seviyelerinin her iki dizde WOMAC indeksi ile korrele olmadığı gösterilse de postoperatif birinci ay WOMAC skorunda postoperatif 1 ay değişikliği sağ dize göre sol dizde daha yüksek bulundu.Çıkarımlar: Biyokimyasal ve fonksiyonel sonuçlar potansiyel İÖE’ye bağlanabilir. Bilateral TDP sırasında turnikeler arasındaki 20 dakikalık süre İÖE yaratabilir ve iskemi-perfüzyon yaralanmasının büyüklüğünü azaltabilir ve daha iyi fonksiyonel sonuçlara neden olabilir
Anahtar Kelimeler
Kaynakça
- Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myo- cardium. Circulation 1986;74:1124–36.
- Garcia-Criado FJ, Eleno N, Santos-Benito F, Valdunciel JJ, Reverte M, Lozano-Sánchez FS, et al. Protective effect of exogenous nitric oxide on the renal function and in- flammatory response in a model of ischemia-reperfusion. Transplantation 1998;66:982–90.
- Oxman T, Arad M, Klein R, Avazov N, Rabinowitz B. Limb ischemia preconditions the heart against reper- fusion tachyarrhythmia. Am J Physiol 1997;273(4 Pt 2):H1707–12.
- Hoshikawa Y, Ono S, Suzuki S, Tanita T, Chida M, Song C, Noda M, et al. Generation of oxidative stress contrib- utes to the development of pulmonary hypertension in- duced by hypoxia. J Appl Physiol (1985) 2001;90:1299– 306.
- Lefer AM, Lefer DJ. The role of nitric oxide and cell ad- hesion molecules on the microcircula-tion in ischaemia- reperfusion. Cardiovasc Res 1996;32:743–51.
- Suzuki M, Inauen W, Kvietys PR, Grisham MB, Meininger C, Schelling ME, et al. Superox-ide mediates reperfusion-induced leukocyte-endothelial cell interac- tions. Am J Physiol 1989;257(5 Pt 2):H1740–5.
- Buttke TM, Sandstrom PA. Oxidative stress as a mediator of apoptosis. Immunol Today 1994;15:7–10.
- Cheng YJ, Wang YP, Chien CT, Chen CF. Small-dose pro- pofol sedation attenuates the for-mation of reactive oxygen species in tourniquet-induced ischemia-reperfusion injury under spinal anesthesia. Anesth Analg 2002;94:1617–20.
- Mohler LR, Pedowitz RA, Myers RR, Ohara WM, Lo- pez MA, Gershuni DH. Intermittent reperfusion fails to prevent posttourniquet neurapraxia. J Hand Surg Am 1999;24:687–93.
- Pedowitz RA. Tourniquet-induced neuromuscular injury. A recent review of rabbit and clini-cal experiments. Acta Orthop Scand Suppl 1991;245:1–33.
- Dillon JP, Laing AJ, Chandler JR, Wang JH, McGuinness A, Redmond HP. Pravastatin at-tenuates tourniquet- induced skeletal muscle ischemia reperfusion injury. Acta Orthop 2006;77:27–32.
- Lee JY, Kim CJ, Chung MY. Effect of high-dose vitamin C on oxygen free radical produc-tion and myocardial enzyme after tourniquet ischaemia-reperfusion injury during bilat- eral total knee replacement. J Int Med Res 2010;38:1519– 29.
- Singla DK, Kaur K, Sharma AK, Dhingra S, Singal PK. Probucol promotes endogenous anti-oxidant reserve and confers protection against reperfusion injury. Can J Physi- ol Pharmacol 2007;85:439–43.
- Kahraman S, Kilinç K, Dal D, Erdem K. Propofol attenu- ates formation of lipid peroxides in tourniquet-induced ischaemia-reperfusion injury. Br J Anaesth 1997;78:279– 81.
- Kingston R, Kelly CJ, Murray P. The therapeutic role of taurine in ischaemia-reperfusion injury. Curr Pharm Des 2004;10:2401–10.
- Atahan E, Ergun Y, Belge Kurutas E, Cetinus E, Guney Er- gun U. Ischemia-reperfusion inju-ry in rat skeletal muscle is attenuated by zinc aspartate. J Surg Res 2007;137:109– 16.
- Koca K, Yurttas Y, Cayci T, Bilgic S, Kaldirim U, Durusu M, et al. The role of precondition-ing and N-acetylcyste- ine on oxidative stress resulting from tourniquet-induced ischemia-reperfusion in arthroscopic knee surgery. J Trau- ma 2011;70:717–23.
- Kharbanda RK, Peters M, Walton B, Kattenhorn M, Mul- len M, Klein N, et al. Ischemic pre-conditioning prevents endothelial injury and systemic neutrophil activation dur- ing ischemia-reperfusion in humans in vivo. Circulation 2001;103:1624–30.
- Gho BCG, Schoemaker RC, Lee CVD, Sharma HS. Transient renalischemia limits myocar-dial infarct size in rats. Eur Heart J 1994;15 Suppl:249.
- Mello Filho AC, Hoffmann ME, Meneghini R. Cell kill- ing and DNA damage by hydrogen peroxide are mediated by intracellular iron. Biochem J 1984;218:273–5.
- Burkhardt H, Schwingel M, Menninger H, Macartney HW, Tschesche H. Oxygen radicals as effectors of car- tilage destruction. Direct degradative effect on matrix components and indirect action via activation of latent collagenase from polymorphonuclear leukocytes. Arthritis Rheum 1986;29:379–87.
- Ward PA. Mechanisms of endothelial cell killing by H2O2 or products of activated neutro-phils. Am J Med 1991;91:89–94.
- Murrell GA, Francis MJ, Bromley L. Modulation of fi- broblast proliferation by oxygen free radicals. Biochem J 1990;265:659–65.
- Olguner C, Koca U, Kar A, Karci A, Işlekel H, Canyilmaz M, et al. Ischemic preconditioning attenuates the lipid per- oxidation and remote lung injury in the rat model of uni- lateral lower limb ischemia reperfusion. Acta Anaesthesiol Scand 2006;50:150–5.
- Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myo- cardium. Circulation 1986;74:1124–36.
- Sha Y, Xu YQ, Zhao WQ, Tang H, Li FB, Li X, et al. Pro- tective effect of ischaemic precon-ditioning in total knee arthroplasty. Eur Rev Med Pharmacol Sci 2014;18:1559– 66.
- Murphy T, Walsh PM, Doran PP, Mulhall KJ. Transcrip- tional responses in the adaptation to ischaemia-reperfu- sion injury: a study of the effect of ischaemic precondi- tioning in total knee arthroplasty patients. J Transl Med 2010;8:46.
- Harkin DW, Barros D’Sa AA, McCallion K, Hoper M, Campbell FC. Ischemic precondition-ing before lower limb ischemia-reperfusion protects against acute lung in- jury. J Vasc Surg 2002;35:1264–73.
- Cheng YJ, Chien CT, Chen CF. Oxidative stress in bilat- eral total knee replacement, under ischaemic tourniquet. J Bone Joint Surg Br 2003;85:679–82.
- Memtsoudis SG, Valle AG, Jules-Elysse K, Poultsides L, Reid S, Starcher B, et al. Periop-erative inflammatory re- sponse in total knee arthroplasty patients: impact of limb preconditioning. Reg Anesth Pain Med. 2010;35:412–6.
- Memtsoudis SG, Stundner O, Yoo D, Gonzalez Della Valle A, Boettner F, Bombardieri AM, et al. Does limb preconditioning reduce pain after total knee arthroplasty? A randomized, dou-ble-blind study. Clin Orthop Relat Res 2014;472:1467–74.
Impact of oxidative stress on early postoperative knee function and muscle injury biochemical markers: Is it possible to create an ischemic preconditioning effect in sequential ischemic surgical procedures?
Öz
Objective: Simultaneous bilateral total knee arthroplasty (TKA) with prolonged tourniquet time has the potential to trigger ischemia-reperfusion injury, which can adversely affect knee function. Studies suggest that the magnitude of injury is less if it occurs following an ischemic event which takes place in another part of the body, known as ischemic preconditioning (IPC). The purpose of this study was to investigate the impact of oxidative stress on muscle injury and knee function and to elucidate if potential IPC effect can attenuate ischemia-reperfusion injury metabolites and prevent poor functional outcomes in single-stage bilateral TKA.
Methods: Thirty patients who underwent single-stage bilateral TKA under tourniquet were enrolled in the study. All procedures were initiated from the right limb. Upon completion of the procedure, the left tourniquet was inflated 20 minutes after the first tourniquet was deflated. The tourniquet time was noted. Pre- and postoperative levels of malondialdehyde (MDH), creatine kinase (CK), and lactate dehydrogenase (LDH) were evaluated. Knee function was assessed postoperatively at 1 month using WOMAC score.
Results: Postoperative levels of MDH, CK, and LDH were significantly increased in both extremities compared to preoperative levels. Serum MDH, CK, and LDH levels were not found to be correlated with tourniquet time for either extremity. Compared to the left extremity, the right extremity revealed increased postoperative oxidative stress, which was indicated by elevated serum MDH, CK, and LDH levels. Although tourniquet time and postoperative serum MDH, CK, and LDH levels were not found to be correlated with WOMAC index in either knee, the average change in WOMAC score at 1 month postoperatively was found to be higher in the left knee compared to the right.
Conclusion: The biochemical and functional outcomes can be attributed to potential IPC effect. During bilateral TKA, a 20-minute interval between tourniquets can create IPC effect and attenuate the magnitude of ischemia-reperfusion injury, preserving better functional outcomes.
Anahtar Kelimeler
Bilateral total knee arthroplasty ischemia-reperfusion injury ischemic precondition effect tourniquet
Kaynakça
- Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myo- cardium. Circulation 1986;74:1124–36.
- Garcia-Criado FJ, Eleno N, Santos-Benito F, Valdunciel JJ, Reverte M, Lozano-Sánchez FS, et al. Protective effect of exogenous nitric oxide on the renal function and in- flammatory response in a model of ischemia-reperfusion. Transplantation 1998;66:982–90.
- Oxman T, Arad M, Klein R, Avazov N, Rabinowitz B. Limb ischemia preconditions the heart against reper- fusion tachyarrhythmia. Am J Physiol 1997;273(4 Pt 2):H1707–12.
- Hoshikawa Y, Ono S, Suzuki S, Tanita T, Chida M, Song C, Noda M, et al. Generation of oxidative stress contrib- utes to the development of pulmonary hypertension in- duced by hypoxia. J Appl Physiol (1985) 2001;90:1299– 306.
- Lefer AM, Lefer DJ. The role of nitric oxide and cell ad- hesion molecules on the microcircula-tion in ischaemia- reperfusion. Cardiovasc Res 1996;32:743–51.
- Suzuki M, Inauen W, Kvietys PR, Grisham MB, Meininger C, Schelling ME, et al. Superox-ide mediates reperfusion-induced leukocyte-endothelial cell interac- tions. Am J Physiol 1989;257(5 Pt 2):H1740–5.
- Buttke TM, Sandstrom PA. Oxidative stress as a mediator of apoptosis. Immunol Today 1994;15:7–10.
- Cheng YJ, Wang YP, Chien CT, Chen CF. Small-dose pro- pofol sedation attenuates the for-mation of reactive oxygen species in tourniquet-induced ischemia-reperfusion injury under spinal anesthesia. Anesth Analg 2002;94:1617–20.
- Mohler LR, Pedowitz RA, Myers RR, Ohara WM, Lo- pez MA, Gershuni DH. Intermittent reperfusion fails to prevent posttourniquet neurapraxia. J Hand Surg Am 1999;24:687–93.
- Pedowitz RA. Tourniquet-induced neuromuscular injury. A recent review of rabbit and clini-cal experiments. Acta Orthop Scand Suppl 1991;245:1–33.
- Dillon JP, Laing AJ, Chandler JR, Wang JH, McGuinness A, Redmond HP. Pravastatin at-tenuates tourniquet- induced skeletal muscle ischemia reperfusion injury. Acta Orthop 2006;77:27–32.
- Lee JY, Kim CJ, Chung MY. Effect of high-dose vitamin C on oxygen free radical produc-tion and myocardial enzyme after tourniquet ischaemia-reperfusion injury during bilat- eral total knee replacement. J Int Med Res 2010;38:1519– 29.
- Singla DK, Kaur K, Sharma AK, Dhingra S, Singal PK. Probucol promotes endogenous anti-oxidant reserve and confers protection against reperfusion injury. Can J Physi- ol Pharmacol 2007;85:439–43.
- Kahraman S, Kilinç K, Dal D, Erdem K. Propofol attenu- ates formation of lipid peroxides in tourniquet-induced ischaemia-reperfusion injury. Br J Anaesth 1997;78:279– 81.
- Kingston R, Kelly CJ, Murray P. The therapeutic role of taurine in ischaemia-reperfusion injury. Curr Pharm Des 2004;10:2401–10.
- Atahan E, Ergun Y, Belge Kurutas E, Cetinus E, Guney Er- gun U. Ischemia-reperfusion inju-ry in rat skeletal muscle is attenuated by zinc aspartate. J Surg Res 2007;137:109– 16.
- Koca K, Yurttas Y, Cayci T, Bilgic S, Kaldirim U, Durusu M, et al. The role of precondition-ing and N-acetylcyste- ine on oxidative stress resulting from tourniquet-induced ischemia-reperfusion in arthroscopic knee surgery. J Trau- ma 2011;70:717–23.
- Kharbanda RK, Peters M, Walton B, Kattenhorn M, Mul- len M, Klein N, et al. Ischemic pre-conditioning prevents endothelial injury and systemic neutrophil activation dur- ing ischemia-reperfusion in humans in vivo. Circulation 2001;103:1624–30.
- Gho BCG, Schoemaker RC, Lee CVD, Sharma HS. Transient renalischemia limits myocar-dial infarct size in rats. Eur Heart J 1994;15 Suppl:249.
- Mello Filho AC, Hoffmann ME, Meneghini R. Cell kill- ing and DNA damage by hydrogen peroxide are mediated by intracellular iron. Biochem J 1984;218:273–5.
- Burkhardt H, Schwingel M, Menninger H, Macartney HW, Tschesche H. Oxygen radicals as effectors of car- tilage destruction. Direct degradative effect on matrix components and indirect action via activation of latent collagenase from polymorphonuclear leukocytes. Arthritis Rheum 1986;29:379–87.
- Ward PA. Mechanisms of endothelial cell killing by H2O2 or products of activated neutro-phils. Am J Med 1991;91:89–94.
- Murrell GA, Francis MJ, Bromley L. Modulation of fi- broblast proliferation by oxygen free radicals. Biochem J 1990;265:659–65.
- Olguner C, Koca U, Kar A, Karci A, Işlekel H, Canyilmaz M, et al. Ischemic preconditioning attenuates the lipid per- oxidation and remote lung injury in the rat model of uni- lateral lower limb ischemia reperfusion. Acta Anaesthesiol Scand 2006;50:150–5.
- Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myo- cardium. Circulation 1986;74:1124–36.
- Sha Y, Xu YQ, Zhao WQ, Tang H, Li FB, Li X, et al. Pro- tective effect of ischaemic precon-ditioning in total knee arthroplasty. Eur Rev Med Pharmacol Sci 2014;18:1559– 66.
- Murphy T, Walsh PM, Doran PP, Mulhall KJ. Transcrip- tional responses in the adaptation to ischaemia-reperfu- sion injury: a study of the effect of ischaemic precondi- tioning in total knee arthroplasty patients. J Transl Med 2010;8:46.
- Harkin DW, Barros D’Sa AA, McCallion K, Hoper M, Campbell FC. Ischemic precondition-ing before lower limb ischemia-reperfusion protects against acute lung in- jury. J Vasc Surg 2002;35:1264–73.
- Cheng YJ, Chien CT, Chen CF. Oxidative stress in bilat- eral total knee replacement, under ischaemic tourniquet. J Bone Joint Surg Br 2003;85:679–82.
- Memtsoudis SG, Valle AG, Jules-Elysse K, Poultsides L, Reid S, Starcher B, et al. Periop-erative inflammatory re- sponse in total knee arthroplasty patients: impact of limb preconditioning. Reg Anesth Pain Med. 2010;35:412–6.
- Memtsoudis SG, Stundner O, Yoo D, Gonzalez Della Valle A, Boettner F, Bombardieri AM, et al. Does limb preconditioning reduce pain after total knee arthroplasty? A randomized, dou-ble-blind study. Clin Orthop Relat Res 2014;472:1467–74.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Orijinal Makale |
| Yazarlar | |
| Yayımlanma Tarihi | 19 Ağustos 2015 |
| Yayımlandığı Sayı | Yıl 2015 Cilt: 49 Sayı: 4 |